Routine inspection·September 10, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:27AM. The LPA was greeted by staff and explained the reason for the visit. Facilty Designee Ernis Sabyrov arrived shortly thereafter. Administrator Elmira (Emma) Sabyrova arrived at approximately 01:00PM. Beginning at 11:52AM, the LPA and Facility Designee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher was observed to be fully charged and purchased on 09/13/2023. Hardwired combination smoke and carbon monoxide detectors were tested at 02:30PM and were operational at the time of the visit. KITCHEN: Knives and sharps were observed in a locked drawer next to the stove. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food and a locked refrigerated medication box. COMMON AREAS: Living and dining room furniture were observed to be in good condition. The LPA observed required postings throughout the common space. The garage is attached to the facility and is locked and inaccessible. Garage contains laundry facilities, extra food, cleaning supplies and emergency food and water. RESTROOMS: The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in a sample of bathrooms and was within the required range. BEDROOMS: There are 6 (six) private resident bedrooms, which were furnished with appropriate linens and Report Continued on LIC 809-C Continued from LIC 809 required furniture. Adequate lighting in all bedrooms was observed. There is 1 (one) staff room which was locked. OUTDOOR SPACE: There are 3 sheds in backyard that are used for storage. All hazardous items were observed locked. The backyard has a covered outdoor area equipped with furniture for resident use. The LPA observed two side gates that are self-closing and latching. Passageways were observed clear of obstructions in case of an emergency. No bodies of water noted at the time of visit. RECORD REVIEW: Record review began at 12:20PM. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. 1 (one) resident (Resident #1 - R1) with a diagnosis of dementia had a medical assessment dated 04/17/2023 and a needs and service appraisal dated 04/21/2023. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff files were in order. MEDICATIONS: Medications review began at 02:55PM; 2 (two) residents' medications were observed. Medications are centrally stored and locked in a mediation cabinet in the kitchen. Medications are documented on the centrally stored medications and destruction record. LPA observed that both residents had medications that had recent changes in orders. Based on the change in orders and days elapsed since the changes, both residents medication counts did not match the amount that should have been distributed. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 05/22/2024. INTERVIEWS: During the visit, LPA interviewed 3 (three) staff and 1 (one) resident. No concerns noted. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.